Do you like what you see when you look in the mirror? If your answer is “No,” you’re not alone. For many of us, there’s a growing gap between how our bodies look and how we’d like them to look.Americans have generally gotten wider and flabbier over the past few decades, as obesity rates continue to climb. But at the same time, the media bombard us with images of people who seem impossibly thin or muscular. The gap between reality and expectations can leave many people feeling inadequate.

It’s normal to look in the mirror occasionally and wish for a firmer body or more glamorous hair. But some people find they can’t stop thinking about body flaws they believe they have. They may avoid going out with friends or even stop going to work because they feel ashamed of their skin, hair, weight or other features.

“They say they look ugly, flawed or deformed, but in reality they look fine,” says Dr. Katharine A. Phillips, a psychiatrist at Brown University. “The physical flaws they perceive are things we can’t see at all, or they’re really quite minimal.”

Having a negative body image like this isn’t just an attitude problem. It can take a toll on your mental and physical health. If excessive thoughts about your body cause great distress or interfere with your daily life, you may have a body image disorder, also known as body dysmorphic disorder (BDD).BDD is a psychiatric condition that affects about 1-2% of the population. It occurs slightly more often in women than in men. “People with BDD frequently think about an imagined defect in their physical appearance. The thoughts are difficult to resist or control,” Phillips says. “On average, these patients report that they think about their perceived appearance flaws for about 3–8 hours a day.”

Because of their imagined flaws, many people with BDD avoid going out in public or shun friends and family. About three-quarters have had major depression, and about 1 in 4 attempt suicide.Much attention has been paid to how culture and the media can damage women’s feelings about their own bodies. But studies suggest that men and boys can also feel they can’t measure up to the broad-shouldered, narrow-waisted, muscular men they see in ads, cartoons, TV shows, movies and even action figures.

“There’s a climate in American society that rewards muscularity and equates it with masculinity,” says Dr. Harrison Pope, a psychiatrist at Harvard Medical School.

Pope and his colleagues have found a wide gap between what men think of their own bodies and what they believe women prefer. In one study, researchers asked men in the U.S. and Europe to select a body size and shape on a computer that they felt matched their own bodies. Then they selected a body that they thought women would find most attractive. On average, the men expected that women would prefer bodies with about 20 pounds more muscle than the men actually had.But when the scientists asked women which body shapes they liked most, “the women chose perfectly ordinary male bodies, without any extra muscle,” Pope says. “The men seemed to have a very distorted view of what women wanted.”

A skewed view of how muscular you are may signal a type of BDD called muscle dysmorphia. It’s sometimes found among bodybuilders. People with the disorder become obsessed with being more muscular. “They might look in a mirror and think that they look small and wimpy, even if they are actually large and muscular,” Pope says. Their poor body image puts them at risk for illegal use of anabolic steroidsand other drugs to gain muscle mass.

“Steroids are extremely effective at building muscle, and they aren’t as negatively perceived as other drugs of abuse,” Pope says. “They can give you bulging upper-body muscles that you could never achieve with even the most dedicated exercise and weight-training.”

But these drug-induced muscles come at a high price. Steroid abuse can lead to serious, sometimes irreversible health problems. It can damage the liver and cause high blood pressure, high cholesterol and skin problems. Growing evidence suggests that steroids can also damage heart muscle. Males may develop breast tissue, and their testicles may shrink. Steroid abuse can also alter certain brain chemicals and affect mood and behavior.

“One surprising effect is that when men take anabolic steroids and gradually become more muscular, they sometimes become more fixated on their body size and even more dissatisfied,” Pope says. “Steroids don’t always relieve body image problems.”

People with BDD, however, might focus on any part of the body. The most common concern is with some aspect of the skin (such as perceived acne or scarring), which occurs in about three-fourths of patients with BDD. Many patients are fixated on their hair or nose. Some worry about their weight, thighs, teeth or face. More than one-third seek cosmetic surgery, although it rarely fixes the appearance problem they believe they have.

BDD can be difficult to diagnose, because affected people look normal and are often too ashamed to talk about their concerns with appearance. Clues include frequent mirror-checking, excessive grooming, skin picking or covering up disliked body parts.

“The good news is that we’re learning a lot about effective treatment for this disorder,” says Phillips. A number of studies suggest that medications known as serotonin-reuptake inhibitors, which are used to treat depression and certain other disorders, can be effective for BDD. A type of therapy known as cognitive-behavioral therapy also seems promising.

If you don’t have a body image disorder, improving your attitude about your body might just be a matter of accepting that healthy bodies come in many shapes and sizes. We all want to look good, but you should never sacrifice your health to try to achieve a “perfect” body.

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